Falling in love but feeling infectious? Therapist Patrick Califia helps you get a grip on HIV intimacy issues

Dear Sexpert:

The good news is, I'm in love. The bad news is, he's negative -- and I'm scared shitless that I'll infect him. It just seems inevitable. Whenever I bring these anxieties up, my boyfriend calmly reassures me that we will always take precautions, use condoms when fucking and deal day by day. But after four months, he is losing patience with my fears and complains that I'm pushing him away. This is the first relationship I have risked since testing positive in 1992 -- I spent a whole decade having sex with strangers -- and I feel hopelessly at sea. We are (were?) hoping to move in together. Save me before I sabotage it.

-- Mixed-Status & Mixed-Up

Dear M&M,

Your upsetness about infecting your beloved shows that you care deeply about him -- and that, as Martha Stewart would say, is a good thing. Creating a safe-sex ritual is something all mixed-status couples must do from scratch, and Martha is no help at all. You just have to start with all your issues open. And take heart that many serodiverse (serodiscordant is so, well, discordant) partnerships succeed beautifully.

It sounds like you feel some shame about the nights you stayed up counting everything but sheep. But you weren't necessarily "avoiding commitment." When the right opportunity to get involved presented itself, you bit. The social and erotic skills you developed when you hit the parks, sex clubs and other cruisey spots can help you build a strong relationship, not hinder it. You got game, my man.

Of course, HIV can make even a sex god feel his touch is toxic. And yet the need for pleasure and intimacy rarely declines with your CD4-cell count -- nor should it. Having sex with strangers is one coping mechanism. There may be a greater sense of freedom if you know the other person is also positive, so some HIVers will cruise only those who share their serostatus. Celibacy may seem like a safe retreat, but it can lead to a sense of deprivation that only encourages acting out. A loving relationship in which each partner accepts the other -- infections, imperfections and all -- may be the best way to handle life's hardships without isolating yourself or drowning in mindless excess.

Your lover-man needs to find some time to open his heart so that you can vent about your anxieties. His solution -- dealing day by day -- is the only pragmatic one, but he's putting it forward too soon; perhaps as a defense against his own fears. Behind his calm reassurance is a hidden message that there is nothing to talk about here, and that's so wrong. Ironically, it would probably make you feel better to hear that he shares your worries. While the guilt you feel about having HIV (or being an erotically adventurous homo) may contribute to your transmission troubles, he needs to unpack his own baggage -- guilt about having escaped the virus, say, or fear about your getting sick someday.

To master your mutual anxieties, communication -- and the trust that it births -- goes a long way. Explore what being positive and negative means to each of you. Accept that you are different from each other and try to respect, even enjoy, the friction this causes. Get graphic about your sexual experiences and fantasies. Linger over the topic of what each thinks is unsafe. This will help you come up with an agreement about what you will and won't do based on your individual comfort levels as well as the medical facts. Do you dream that it would be easier if you were both positive? Expressing such wishes, even if they must not come true, can defuse their power. Taking sexual risks is often an attempt to deny differences, to prove one's love or to express anger about the virus. It's easier, not harder, to use condoms if you can talk about the ways they limit pleasure. Does the inability to share fluids feel like a loss? Give tongue to it. And have a back-up plan in case a condom breaks: quick access to post-exposure prophylaxis.

Are you sabotaging a good thing? Although it is self-destructive to reject love, it can feel right -- like infecting your beloved, "it just seems inevitable" -- if deep-down we don't believe we deserve happiness. The HIV issue may loom so large that it obscures other obstacles to intimacy, such as why you may feel "safer" alone. This is where a therapist can work wonders. The secrets we keep from each other and ourselves wind up making us run in circles and breaking leases.

Repeat after me: HIV is not the only threat to human happiness. We will all die of something. This tragedy is only enhanced when we refuse to connect with each other in the short time we do have. Men and women marry, and their gender differences can wreak more havoc than any retrovirus. Bet you a subscription to Martha Stewart Living and a gross of Rough Riders that you and Mr. Right will have a better relationship than your parents managed.